scholarly journals Effect of nasal noninvasive respiratory support methods on pharyngeal provocation-induced aerodigestive reflexes in infants

2016 ◽  
Vol 310 (11) ◽  
pp. G1006-G1014 ◽  
Author(s):  
Sudarshan R. Jadcherla ◽  
Kathryn A. Hasenstab ◽  
Swetha Sitaram ◽  
Brian J. Clouse ◽  
Jonathan L. Slaughter ◽  
...  
Keyword(s):  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Delivery Methods ◽  
Bolus Transit ◽  
Contraction Duration ◽  
Life Threatening ◽  
Pharyngoesophageal Manometry ◽  
Support Methods ◽  
The Impact ◽  
Esophageal Contraction

The pharynx is a locus of provocation among infants with aerodigestive morbidities manifesting as dysphagia, life-threatening events, aspiration-pneumonia, atelectasis, and reflux, and such infants often receive nasal respiratory support. We determined the impact of different oxygen delivery methods on pharyngeal stimulation-induced aerodigestive reflexes [room air (RA), nasal cannula (NC), and nasal continuous positive airway pressure (nCPAP)] while hypothesizing that the sensory motor characteristics of putative reflexes are distinct. Thirty eight infants (28.0 ± 0.7 wk gestation) underwent pharyngoesophageal manometry and respiratory inductance plethysmography to determine the effects of graded pharyngeal stimuli ( n = 271) on upper and lower esophageal sphincters (UES, LES), swallowing, and deglutition-apnea. Comparisons were made between NC ( n = 19), nCPAP ( n = 9), and RA ( n = 10) groups. Importantly, NC or nCPAP (vs. RA) had: 1) delayed feeding milestones ( P < 0.05), 2) increased pharyngeal waveform recruitment and duration, greater UES nadir pressure, decreased esophageal contraction duration, decreased distal esophageal contraction amplitude, and decreased completely propagated esophageal peristalsis (all P < 0.05), and 3) similarly developed UES contractile and LES relaxation reflexes ( P > 0.05). We conclude that aerodigestive reflexes were similarly developed in infants using noninvasive respiratory support with adequate upper and lower aerodigestive protection. Increased concern for GERD is unfounded in this population. These infants may benefit from targeted oromotor feeding therapies and safe pharyngeal bolus transit to accelerate feeding milestones.

scholarly journals Passive Tracer Visualization to Simulate Aerodynamic Virus Transport in Noninvasive Respiratory Support Methods

Respiration ◽  
2021 ◽  
pp. 1-12
Author(s):  
Rutger Hendrik Johan Hebbink ◽  
Judith Elshof ◽  
Steven Wanrooij ◽  
Walter Lette ◽  
Mariëtte Lokate ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Respiratory Support ◽  
Droplet Dispersion ◽  
Bilevel Positive Airway Pressure ◽  
Increased Risk ◽  
Exhaled Air ◽  
Support Methods ◽  
Jet Velocities

<b><i>Background:</i></b> Various forms of noninvasive respiratory support methods are used in the treatment of hypoxemic CO­VID-19 patients, but limited data are available about the corresponding respiratory droplet dispersion. <b><i>Objectives:</i></b> The aim of this study was to estimate the potential spread of infectious diseases for a broad selection of oxygen and respiratory support methods by revealing the therapy-induced aerodynamics and respiratory droplet dispersion. <b><i>Methods:</i></b> The exhaled air-smoke plume from a 3D-printed upper airway geometry was visualized by recording light reflection during simulated spontaneous breathing, standard oxygen mask application, nasal high-flow therapy (NHFT), continuous positive airway pressure (CPAP), and bilevel positive airway pressure (BiPAP). The dispersion of 100 μm particles was estimated from the initial velocity of exhaled air and the theoretical terminal velocity. <b><i>Results:</i></b> Estimated droplet dispersion was 16 cm for unassisted breathing, 10 cm for Venturi masks, 13 cm for the nebulizer, and 14 cm for the nonrebreathing mask. Estimated droplet spread increased up to 34 cm in NHFT, 57 cm in BiPAP, and 69 cm in CPAP. A nonsurgical face mask over the NHFT interface reduced estimated droplet dispersion. <b><i>Conclusions:</i></b> During NHFT and CPAP/BiPAP with vented masks, extensive jets with relatively high jet velocities were observed, indicating increased droplet spread and an increased risk of droplet-driven virus transmission. For the Venturi masks, a nonrebreathing mask, and a nebulizer, estimated jet velocities are comparable to unassisted breathing. Aerosols are transported unboundedly in all these unfiltered therapies. The adequate use of protective measures is of vital importance when using noninvasive unfiltered therapies in infectious respiratory diseases.

scholarly journals Improved COVID-19 outcomes in a large non-invasive respiratory support cohort despite emergence of the alpha variant

2021 ◽  
Vol 8 (1) ◽  
pp. e001044
Author(s):  
Chris D Turnbull ◽  
Benedict M L Porter ◽  
Sarah B Evans ◽  
Oliver Smith ◽  
Rachel Lardner ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Single Centre ◽  
Non Invasive ◽  
High Dependency ◽  
Single Centre Experience ◽  
Alpha Variant ◽  
The Impact ◽  
Second Wave

IntroductionRespiratory high-dependency units (rHDUs) are used to manage respiratory failure in COVID-19 outside of the intensive care unit (ICU). The alpha variant of COVID-19 has been linked to increased rates of mortality and admission to ICU; however, its impact on a rHDU population is not known. We aimed to compare rHDU outcomes between the two main UK waves of COVID-19 infection and evaluate the impact of the alpha variant on second wave outcomes.MethodsWe conducted a single-centre, retrospective analysis of all patients with a diagnosis of COVID-19 admitted to the rHDU of our teaching hospital for respiratory support during the first and second main UK waves.ResultsIn total, 348 patients were admitted to rHDU. In the second wave, mortality (26.7% s vs 50.7% first wave, χ2=14.7, df=1, p=0.0001) and intubation rates in those eligible (24.3% s vs 58.8% first wave, χ2=17.3, df=2, p=0.0002) were improved compared with the first wave. In the second wave, the alpha variant had no effect on mortality (OR 1.18, 95% CI 0.60 to 2.32, p=0.64). Continuous positive airway pressure (CPAP) (89.5%) and awake proning (85.6%) were used in most patients in the second wave.DiscussionOur single-centre experience shows that rHDU mortality and intubation rates have improved over time in spite of the emergence of the alpha variant. Our data support the use of CPAP and awake proning, although improvements in outcome are likely to be multifactorial.

Nasopharyngeal CPAP: A Nursing Art

2001 ◽  
Vol 20 (6) ◽  
pp. 9-16 ◽  
Author(s):  
Susan Berends
Keyword(s):  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Respiratory Support ◽  
Careful Attention ◽  
Delivery Methods

CPAP, the use of continuous positive airway pressure as a means of providing respiratory support to the infant, has been studied since the early 1970s. A variety of delivery methods has been used. One method, that of providing CPAP through a single nasopharyngeal tube, is reviewed here. The process of delivering nasopharyngeal CPAP can be technically difficult, and requires careful attention to the infant and the CPAP system. The ability to anticipate and troubleshoot problems is essential. Done well, this process truly shows off the art of nursing.

Alteraciones sistémicas y metabólicas producidas por lesión medular

2019 ◽  
Vol 1 (1) ◽  
pp. 59-75
Author(s):  
Gabriel Guízar Sahagún
Keyword(s):  
Spinal Cord ◽  
Daily Living ◽  
Autonomic Function ◽  
Clinical Presentation ◽  
Scientific Literature ◽  
International Standards ◽  
Therapeutic Approaches ◽  
Cord Injury ◽  
Life Threatening ◽  
The Impact

Besides the well-known loss of motor and sensory capabilities, people with spinal cord injury (SCI) experience a broad range of systemic and metabolic abnormalities including, among others, dysfunction of cardiovascular, respiratory, gastrointestinal, urinary, and endocrine systems. These alterations are a significant challenge for patients with SCI because such disorders severely interfere with their daily living and can be potentially life-threatening. Most of these disorders are associated with impairment of regulation of the autonomic nervous system, arising from disruption of connections between higher brain centers and the spinal cord caudal to the injured zone. Thus, the higher and more complete the lesion, the greater the autonomic dysfunction and the severity of complications.This article summarizes the medical scientific literature on key systemic and metabolic alterations derived of SCI. It provides information primarily focused on the pathophysiology and clinical presentation of these disorders, as well as some guides to prevent and alleviate such complications. Due to the impact of these alterations, this topic must be a priority and diffuse to those involved with the care of people with SCI, including the patient himself/herself. We consider that any collaborative effort should be supported, like the development of international standards, to evaluate autonomic function after SCI, as well as the development of novel therapeutic approaches.

Gendered Impact of Corruption in Healthcare Service Delivery in Nigeria

2013 ◽  
Vol 11 (1) ◽  
Author(s):  
Yetunde A. Aluko
Keyword(s):  
Service Delivery ◽  
Public Hospitals ◽  
Public Health Care ◽  
Women's Voices ◽  
Medical Supplies ◽  
Poor Women ◽  
Level Information ◽  
Life Threatening ◽  
Threatening Situation ◽  
The Impact

This paper supports the hypothesis that corruption and non-delivery of services in key sectors such as health have gender-specific poverty consequences. The study utilized qualitative micro-level information about the structures of corruption and its impact on poor women. Respondents expressed their perceptions on the occurrence of corrupt practices in public health care system and its wider impact on society. The findings revealed that the impact of corruption is felt disproportionately by women and the poor, who are most dependent on public services, and have no alternative even when facing corrupt practices in a life threatening situation, such as complicated birth delivery. Pregnant women denied access to doctors tended to deliver at home, which increased the likelihood of complications and maternal and child mortality. Medical supplies meant for public hospitals are sold to private clinics who charge more for drugs and supplies. There is need to strengthen sectoral oversight mechanisms and transparency as well as increase women’s voices in service delivery.

The management of Hemorrhoidal Disease by Dearterialization and Mucopexy.

2020 ◽  
Vol 15 ◽  
Author(s):  
Veronica De Simone ◽  
Francesco Litta ◽  
Angelo Parello ◽  
Paola Campennì ◽  
Raffaele Orefice ◽  
...  
Keyword(s):  
Postoperative Management ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Doppler Probe ◽  
Minimally Invasive Surgical ◽  
Bowel Movements ◽  
Excessive Strain ◽  
Life Threatening ◽  
Hemorrhoidal Prolapse ◽  
The Impact

: Several minimally invasive surgical procedures have been recently developed to treat hemorrhoids without any excision. About 25 years ago, a non-excisional procedure providing doppler-guided ligation of the hemorrhoidal arteries has been proposed - named “hemorrhoidal dearterialization”. The original technique has been modified over the years, and indications were expanded. In particular, a plication of the redundant and prolapsing mucosa/submucosa of the rectum (named “mucopexy”) has been introduced to treat hemorrhoidal prolapse, without excision of the hemorrhoidal piles. At present, the THD® Doppler procedure is one of the most used techniques to treat hemorrhoids. Aim of this technique is to realize a target dearterialization, using a Doppler probe with the final purpose to reduce the arterial overflow to the hemorrhoidal piles. In case of associated hemorrhoidal prolapse, a mucopexy is performed together with Doppler-guided dearterialization. The entity and circumferential extension of the hemorrhoidal prolapse guides the mucopexy, which can be considered tailored to a single patient; the dearterialization should be considered mandatory. Advantages of this surgical technique are the absence of serious and life-threatening postoperative events, chronic complications, and limited recurrence risks. The impact of the procedure on the anorectal physiology is negligible. However, a careful postoperative management is mandatory to avoid complications and to guarantee an improved long-term outcome. Therefore, regular physiologic bowel movements, excessive strain at the defecation and strong physical activity are advisable.

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

scholarly journals The Global Registry for Hereditary Angioedema due to C1-Inhibitor Deficiency

2021 ◽  
Author(s):  
Andrea Zanichelli ◽  
Henriette Farkas ◽  
Laurance Bouillet ◽  
Noemi Bara ◽  
Anastasios E. Germenis ◽  
...  
Keyword(s):  
Hereditary Angioedema ◽  
Rare Condition ◽  
C1 Inhibitor ◽  
C1 Inhibitor Deficiency ◽  
Therapeutic Decisions ◽  
Life Threatening ◽  
Enhance Patient Care ◽  
Electronic Support ◽  
The Impact ◽  
Global Registry

AbstractHereditary angioedema (HAE) is a rare condition, mostly due to genetic deficiency of complement C1 inhibitor (C1-INH). The rarity of HAE impedes extensive data collection and assessment of the impact of certain factors known to affect the course of this disabling and life-threatening disease. Establishing a global registry could assist to overcome such issues and provides valuable patient data from different countries. The HAE Global Registry is a disease-specific registry, with web-based electronic support, where data are provided by physicians and patients through a dedicated application. We collected data between January 1, 2018, and August 31, 2020. Data on 1297 patients from 29 centers in 5 European countries were collected. At least one attack was recorded for 497 patients during the study period. Overall, 1182 patients were diagnosed with HAE type 1 and 115 with type 2. At the time of database lock, 389 patients were taking long-term prophylactic medication, 217 of which were on danazol. Most recorded attacks affected the abdomen, were generally moderate in severity, and occurred in patients who were not on prophylactic treatment (70.6%, 6244/8848). The median duration of attacks was 780 min (IQR 290–1740) in patients on prophylactic medication and 780 min (IQR 300–1920) in patients not on continuous prophylactic medication. In conclusion, the establishment of a registry for C1-INH-HAE allowed collection of a large amount of data that may help to better understand the clinical characteristics of this disease. This information may enhance patient care and guide future therapeutic decisions.

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